Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: An appropriateness ratings evaluation

Tom Blakeman, Kathryn Griffith, Dan Lasserson, Berenice Lopez, Jung Y. Tsang, Stephen Campbell, Charles Tomson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. Design: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Setting: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. Participants: A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. Results: There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. Conclusions: The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs

Original languageEnglish
Article numbere012865
Pages (from-to)1-11
Number of pages11
JournalBMJ Open
Volume6
Issue number10
DOIs
Publication statusPublished - Oct 2016
Externally publishedYes

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Acute Kidney Injury
Primary Health Care
General Practitioners
Communication
Medicalization
Hyperkalemia
Clinical Pathology
Emergency Medicine
Clinical Medicine
antineoplaston A10
National Health Programs
Telephone
General Practice
England
Health Care Costs
Biochemistry
Research

Cite this

Blakeman, Tom ; Griffith, Kathryn ; Lasserson, Dan ; Lopez, Berenice ; Tsang, Jung Y. ; Campbell, Stephen ; Tomson, Charles. / Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: An appropriateness ratings evaluation. In: BMJ Open. 2016 ; Vol. 6, No. 10. pp. 1-11.
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abstract = "Objectives: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. Design: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Setting: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. Participants: A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. Results: There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5{\%}) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5{\%}) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. Conclusions: The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs",
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Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: An appropriateness ratings evaluation. / Blakeman, Tom; Griffith, Kathryn; Lasserson, Dan; Lopez, Berenice; Tsang, Jung Y.; Campbell, Stephen; Tomson, Charles.

In: BMJ Open, Vol. 6, No. 10, e012865, 10.2016, p. 1-11.

Research output: Contribution to journalArticle

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AU - Blakeman, Tom

AU - Griffith, Kathryn

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AU - Lopez, Berenice

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AU - Campbell, Stephen

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AB - Objectives: Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. Design: An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. Setting: Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. Participants: A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. Results: There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. Conclusions: The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs

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